德意志 Forschungsgemeinschaft (德国研究协会;为 2240 "(淋巴) 血管生成和细胞免疫在眼睛炎症性疾病" 到台基;他 6743/2-1 和他 6743/3-1 到台基), 科隆大学 GEROK 计划克尔克和台基。我们感谢 Dr. Kühner 的技术支持。

在这一过程中, 需要得到知情同意, 并已为在德国科隆科隆大学眼科科接受过手术的每一位患者获得了批准。所有检查和手术干预都是按照国家法律和1975年的赫尔辛基宣言在其当前版本中执行的. 
 注意: 除非另有说明, 否则指令将始终仅指执行过程的一侧。使用灭菌设备. 
 1. 患者准备 <ol> <li> 执行彻底的眼科检查 (特别注意眼睑、上、下泪和撕裂引流), 包括冲洗和探查潘多 10.
	<ol> <li> 对于标准化灌溉, 将 Bangerter 探针插入上部, 随后将泪。先将其垂直插入, 然后将其倾斜到寺庙的水平位置, 以跟随小的生理形成。当探头就位时, 仔细注射生理盐水以检测泪道阻塞. 
		注: 在 infrasaccal 潘多, Bangerter 套管很容易到达侧壁, 没有弹性阻力 (和 #34; 硬停止和 #34;)。试图灌溉将导致对侧反流通过对面的泪没有任何液体到达病人和 #39; 咽 10 . </li>
	</ol> </li> <li> 排除急性感染、撕裂引流系统肿瘤以及外伤、先天性或 presaccal 梗阻。
	<ol> <li> 排除急性感染, 寻找痛苦的发红, 肿胀或脓性流出的泪引流。排除肿瘤, 寻找惰性肿胀, 溃疡或色素沉着。Presaccal 梗阻导致 Bangerter 探针进入泪腺囊 (#34; 软停止和 #34;)。先天性和外伤性梗阻可以排除患者病史 10 , 19 , 20 。
	</ol> </li> <li> 排除鼻腔 rhinological 的病态, 如严重的隔膜偏差。这应该是采取的病人和 #39 的历史, 并与 rhinological 检查鼻腔腔的结合 21 . </li>
	<li> 将患者置于全身麻醉下, 如静脉注射异丙酚、瑞芬太尼和阿曲库, 用于诱导和吸入 desfluran 加静脉注射瑞芬太尼用于维持, 使用标准的重量调整剂量 10 . 插管应进行, 但也可以使用喉罩. 
	注: 麻醉药和剂量可能不同的诊所之间。激光辅助 DCR 不需要特定的麻醉方案. </li>
</ol> 2。激光辅助 DCR <ol> <li> 将视频辅助内窥镜插入鼻腔, 通过鼻孔仔细推进。通过略微倾斜内窥镜向侧鼻壁可视化中鼻甲前缘. </li>
	<li> 将激光设备和激光设置设置为正确的值。戴上防护眼镜
	<ol> <li> 将激光光纤 (直径400和 #181; m) 连接到二极管激光器 (波长 810 nm)。设置二极管激光器设置为 6-8 W, 200 毫秒脉冲持续时间, 100 毫秒博览会暂停. </li>
		<li> 将激光光纤放入手片中进行机动和通过钝套管。让 2-3 毫米的纤维坚持在套管的尖端. </li>
		<li> 通过将激光纤维放在木铲上进行碳化, 并在几秒钟内应用镭射能量, 直到尖端足够黑. 
		注意: 这将限制不必要的能量分布到泪腺囊的组织. </li>
	</ol> </li> <li> 在侧鼻壁上正确定位激光纤维。
	<ol> <li> 使用泪腺探针放大和 #160; 下泪 ( 图 2a )。先将探针插入垂直方向, 然后在进一步向泪腺囊推进前将探头带入水平方向。这将允许在下一步中顺利插入激光光纤. </li>
		<li> 将激光光纤插入下小 ( 图 2b , 2c )。先将其垂直插入, 然后将其倾斜到寺庙的水平位置, 以跟随下部小的生理形成. </li>
		<li> 小心地将激光纤维推进到泪腺囊中, 直至触及侧鼻壁, 即内侧泪 saccal 壁。在那里, 以前的方向瞄准尖端, 使它指向中鼻甲的前缘. </li>
		<li> 通过在中鼻甲前边缘的高度监视瞄准光束的 transluminescence ( 图 2d ), 验证正确的定位内. </li>
	</ol> </li> <li> 通过将脉冲激光能量应用于鼻腔壁来创建足够的鼻泪旁路。
	<ol> <li> 应用激光能量 (使用上述参数设置), 保持与墙壁的恒定接触而不受压力, 瞄准中鼻甲的前缘。激光将直接在它前面蒸发组织, 创建一个鼻泪旁路 ( 图 2d , 2e )。
		注: 所需的总能量范围介于 0.9-1.8 焦, 并趋于不同的病人之间. </li>
		<li> 确保光纤笔尖没有主动按下墙壁。注意不要让笔尖滑回金属套管, 因为这会导致金属发热引起的热损伤。也避免侧向运动, 因为尖端可以折断. </li>
		<li> 在穿透侧壁时, 将激光纤维向后拉一点, 并通过仔细地将边缘以圆形方式汽化来扩大口口。尽量创建尽可能大的旁路 ( 图 2f ). </li>
		<li> 针对口口的总直径为5毫米. </li>
		通过仔细地缩回设备, <li> 停止应用能量并将激光纤维与手片和套管一起取出. </li>
	</ol> </li> <li> 通过使用 Bangerter 探头在1.1.1 中描述的盐水冲洗来验证口口的通畅性。如果发明了一个专利口, 成功的灌溉应该是可见的内. </li>
	<li> 删除 Bangerter 探测器. </li>
	<li> 放置硅管 ( 图 2g )。
	<ol> <li> 通过下泪, 插入一个 monocanalicular 硅管, 并小心推进它, 直到领先的金属尖端通过骨口和凸出到鼻腔. </li>
		<li> 使用 Blakesley 钳从鼻腔内抓取尖端, 并将硅管拉出机头并进入位置 ( 图 2h ). </li>
		<li> 使用一对剪刀来缩短硅管。最终不应该被伸出鼻子. </li>
		<li> 通过上部小执行硅胶插管 (以下步骤2.7.1 通过 2.7.3) ( 图 2h ). </li>
	</ol> </li> <li> 删除鼻内窥镜. </li> </ol>
 3. 术后护理和随访 <ol> 手术后, 用抗生素启动治疗e 滴 (如氧氟沙星), 充血滴眼液 (如 xylometazolin) 和甾体滴眼液 (如醋酸泼尼松龙)。抗生素可以在一周后停止, 而类固醇和充血的眼药水应该在一个月的过程中慢慢断奶. </li>
	<li> 手术后六周和三月随访。寻找症状的解决, 硅管脱垂, 感染和分泌. </li>
	<li> 在手术后三月内取出硅管, 只需在点的高度抓住 T 形末端, 然后小心地拉出. </li>
</ol>

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没有利益冲突。

Transcanalicular 激光辅助 DCR 如上所述是一个相当快速, 微创的方式来治疗绝对 infrasaccal 鼻泪管阻塞有效地不需要皮肤切口, 从而节省不仅皮肤, 而且内侧眦肌腱和生理小泵的机理。虽然该程序非常适合于患有鼻泪管阻塞的患者, 但非特发性狭窄的病症不符合此程序。这是由于, 部分, 因为它不允许全面检查泪腺囊或活检不典型的结果是采取19,20,<sup cl...

Infrasaccal 原发性后天性鼻泪管阻塞 (潘多) 是一种常见的疾病, 在 middle-aged 和老年患者导致慢性溢和睑, 以及复发或慢性泪囊炎。最常见的情况是, 患者会出现一个或两个鼻泪导管的 infrasaccal 阻塞, 导致泪液引流不足。
在治疗潘多, 外部泪囊鼻腔切除术 (DCR) 仍然被认为是金标准, 尽管这个过程历史上追溯到100年前, 当它是第一次执行1。经皮下切口和泪囊鼻壁的制备, 用钻头制造出通向鼻腔的骨口, 绕过阻塞的导管。已报告此方法2,3的功能成功率超过85%。然而, 这些结果是以执行一个相对侵入性的手术的成本来承担风险的眼睑的内侧结构包括生理小泵机制4,5 , 并可能给患者留下不受欢迎的疤痕, 虽然现代 nasojugal 皮肤切口有改善的结果。这些风险是潜在的可避免通过执行较少侵入技术或选择一个鼻的方法。
为了规避侵入性手术, 在微创泪流再通领域做了大量的工作。两种方法, 特别是建立了潜在的第一步程序: microdrill dacryoplasty 和激光辅助 dacryoplasty。这些程序是基于 transcanalicular 内窥镜的泪引流系统, 可以执行治疗段膜狭窄的鼻泪管。虽然只有微创和特点的快速 reconvalescence, 这些正值技术的共同缺点是相对较低的功能成功率关于长期的结果6,7,8,9。
为了填补这些第一步程序和外部 DCR 之间的空白, 作为一种明确的治疗方法, 最近已经制定了新的办法。最有希望的是激光辅助 DCR 治疗绝对 infrasaccal 潘多。像所有上述的方法, 病人建议被置于全身麻醉的程序。二极管激光纤维通过小插入, 然后进入泪囊。接下来, 将激光能量应用到侧鼻壁上, 直到形成一个骨口, 在中鼻甲的前边缘的高度连接到鼻腔,10,11。持续的视觉控制一直使用鼻内窥镜。新形成的吻合口用作泪引流的旁路。成功的灌溉后, bicanalicular 硅插管, 以防止早期疤痕的新形成的口。术后治疗包括充血、甾体和抗生素滴眼液, 分别预防肿胀、炎症和感染。
手术时间和 reconvalescence 一般短于外部 DCR (10-25 分钟的激光辅助 DCR vs 35-75 分钟外 DCR)。并发症率较低, 最常见的是离散肿胀的眼睑和硅胶管脱垂。小感染和热损伤是罕见的事件10。一年功能成功率为 74-88% 已报告10,11,12,13,14,15,16, 17,18, 因此在外部 DCR 的后面, 不受外部手术方法的不利因素的困扰。然而, 长期的结果仍有待提供。此外, 即使在激光辅助 DCR 失败后, 次级外部 DCR 仍然可以执行, 没有困难。因此, 激光辅助 DCR 有资格作为一个可行的第二步的程序, 应最好地进行后再通手术失败和外部 DCR。

<table border="0" cellpadding="0" cellspacing="0" width="812">
	<tbody>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">C1.multi</td>
			<td style="width:281px;">LUT</td>
			<td style="width:119px;">05.0082h.1</td>
			<td style="width:196px;">Endoscope camera</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">HL 250</td>
			<td style="width:281px;">LUT</td>
			<td style="width:119px;">95.2048n</td>
			<td>Endoscope light source</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">MD-19E</td>
			<td style="width:281px;">ACL GmbH</td>
			<td style="width:119px;">1119</td>
			<td>Endoscope screen</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">FOX (laser)</td>
			<td style="width:281px;">A.R.C. Laser GmBH, N&#252;rnberg, Germany</td>
			<td style="width:119px;">n/a</td>
			<td>Diode laser</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">Laser fiber</td>
			<td style="width:281px;">A.R.C. Laser GmBH, N&#252;rnberg, Germany</td>
			<td style="width:119px;">LL13001s</td>
			<td>Laser fiber</td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;width:216px;">Laser handpiece</td>
			<td style="width:281px;">A.R.C. Laser GmBH, N&#252;rnberg, Germany</td>
			<td style="width:119px;">n/a</td>
			<td>Handpiece</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">Wide Collarette Monoka</td>
			<td style="width:281px;">Fa. FCL, Paris, France</td>
			<td style="width:119px;">S1.1630</td>
			<td>monocanalicular silicon tube</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">Suction elevatorium</td>
			<td style="width:281px;">Storz</td>
			<td style="width:119px;">474015</td>
			<td>For intranasal use</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">Forceps (Gr&#252;nwald)</td>
			<td style="width:281px;">Storz</td>
			<td style="width:119px;">426620</td>
			<td>For intranasal use</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">Forceps (Blakesley-Wilde)</td>
			<td style="width:281px;">Storz</td>
			<td style="width:119px;">456502</td>
			<td>To grab the silicon tube</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">Lacrimal canula</td>
			<td style="width:281px;">Storz</td>
			<td style="width:119px;">81071</td>
			<td>Blunt cannula</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">Bangerter probe cannula</td>
			<td style="width:281px;">Storz</td>
			<td style="width:119px;">81055</td>
			<td>Bangerter probe cannula</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">Wooden spatula</td>
			<td style="width:281px;">any</td>
			<td style="width:119px;">n/a</td>
			<td>Wooden spatula</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">Xylometazolin 0.05% eye drops</td>
			<td>GlaxoSmithKline Consumer Healthcare</td>
			<td style="width:119px;">n/a</td>
			<td>Decongestant eye drops</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">Dexapos comod eye drops</td>
			<td style="width:281px;">Ursapharm</td>
			<td style="width:119px;">n/a</td>
			<td>steroid eye drops</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">Floxal eye drops</td>
			<td style="width:281px;">Dr. Gerhard Mann</td>
			<td style="width:119px;">n/a</td>
			<td>antibiotic eye drops</td>
		</tr>
	</tbody>
</table>

transcanalicular diode laser-assisted dacryocystorhinostomy for the treatment of primary acquired nasolacrimal duct obstruction

今天的金标准在治疗 infrasaccal 原发性后天性鼻泪管阻塞 (潘多) 是外部泪囊鼻腔切除术 (DCR), 一个相对侵入的程序, 可以执行后, 失败的正值治疗。然而, 随着二极管激光技术领域的进步, 新的方法已经出现。激光辅助 transcanalicular DCR 与后续 bicanalicular 硅插管是一个新的选择, 显示了巨大的承诺作为一个可行的微创手术。在鼻腔的永久性内窥镜视觉控制下, 将一根二极管激光纤维插入泪囊, 应用激光能量在泪腺囊和鼻腔之间形成一个骨口。由于不需要做皮肤切口, 这种方法的优点包括皮肤的保留, 以及内侧眼睑结构和生理眼睑-小泵机构。手术时间和 reconvalescence 一般短于外 DCR。并发症包括硅胶管脱垂, 轻度肿胀, 很少, 小感染和热损伤。一年的功能成功率, 定义为完全解决症状和口通畅, 是高, 但仍然在后面的外部 DCR。但是, 在激光辅助 DCR 失败后的二次外部 DCR 可以毫不费力地进行。因此, 激光辅助 transcanalicular DCR 是一个有效的选择, 应考虑作为第二步的过程后, 再通程序的失败和外部 DCR。

最佳结果:
上述过程大约需要 10-25 分钟, 而且通常是很好的耐受。第二天检查后, 大约60% 的病例会出现眼睑肿胀。这种小肿块总是在最多三天内完全解决。患者不抱怨疼痛, 硅脱垂或受伤或感染的迹象。然而, 由于 bicanalicular 硅插管正在执行过程中, 溢可能坚持, 直到管被删除。局部应用抗生素, 甾体, 充血眼术后是必要的, 病人需?...

Watch this Scientific Journal Video about Transcanalicular Diode Laser-assisted Dacryocystorhinostomy for the Treatment of Primary Acquired Nasolacrimal Duct Obstruction at JoVE.com

Transcanalicular Diode Laser-assisted Dacryocystorhinostomy for the Treatment of Primary Acquired Nasolacrimal Duct Obstruction

本议定书的目的是提出 transcanalicular 激光辅助泪囊鼻腔吻合术作为一种微创方法治疗原发性后天性鼻泪管阻塞。

Transcanalicular 二极管激光辅助泪囊鼻腔吻合术治疗原发性鼻泪管阻塞

Today&#39;s gold standard in the treatment of infrasaccal primary acquired nasolacrimal duct obstruction (PANDO) is external dacryocystorhinostomy (DCR), ...

transcanalicular-diode-laser-assisted-dacryocystorhinostomy-for

Research

JoVE Journal

Medicine

10.9K 次观看.  University of Cologne. 本议定书的目的是提出 transcanalicular 激光辅助泪囊鼻腔吻合术作为一种微创方法治疗原发性后天性鼻泪管阻塞。

视频: Transcanalicular Diode Laser-assisted Dacryocystorhinostomy for the Treatment of Primary Acquired Nasolacrimal Duct Obstruction

Thermal Ablation for the Treatment of Abdominal Tumors

Percutaneous thermal ablation is an emerging treatment option for many tumors of the abdomen not amenable to conventional treatments. During a thermal ablation procedure, a thin applicator is guided into the target tumor under imaging guidance. Energy is then applied to the tissue until temperatures rise to cytotoxic levels (50-60 &deg;C). Various energy sources are available to heat biological tissues, including radiofrequency (RF) electrical current, microwaves, laser light and ultrasonic waves. Of these, RF and microwave ablation are most commonly used worldwide.
During RF ablation, alternating electrical current (~500 kHz) produces resistive heating around the interstitial electrode. Skin surface electrodes (ground pads) are used to complete the electrical circuit. RF ablation has been in use for nearly 20 years, with good results for local tumor control, extended survival and low complication rates1,2. Recent studies suggest RF ablation may be a first-line treatment option for small hepatocellular carcinoma and renal-cell carcinoma3-5. However, RF heating is hampered by local blood flow and high electrical impedance tissues (eg, lung, bone, desiccated or charred tissue)6,7. Microwaves may alleviate some of these problems by producing faster, volumetric heating8-10. To create larger or conformal ablations, multiple microwave antennas can be used simultaneously while RF electrodes require sequential operation, which limits their efficiency. Early experiences with microwave systems suggest efficacy and safety similar to, or better than RF devices11-13.
Alternatively, cryoablation freezes the target tissues to lethal levels (-20 to -40 &deg;C). Percutaneous cryoablation has been shown to be effective against RCC and many metastatic tumors, particularly colorectal cancer, in the liver14-16. Cryoablation may also be associated with less post-procedure pain and faster recovery for some indications17. Cryoablation is often contraindicated for primary liver cancer due to underlying coagulopathy and associated bleeding risks frequently seen in cirrhotic patients. In addition, sudden release of tumor cellular contents when the frozen tissue thaws can lead to a potentially serious condition known as cryoshock 16.
Thermal tumor ablation can be performed at open surgery, laparoscopy or using a percutaneous approach. When performed percutaneously, the ablation procedure relies on imaging for diagnosis, planning, applicator guidance, treatment monitoring and follow-up. Ultrasound is the most popular modality for guidance and treatment monitoring worldwide, but computed tomography (CT) and magnetic resonance imaging (MRI) are commonly used as well. Contrast-enhanced CT or MRI are typically employed for diagnosis and follow-up imaging.

A thermal tumor ablation procedure is described. The entire procedure is detailed, including pretreatment planning and imaging studies, anesthesia, adjuvant techniques to facilitate a percutaneous approach, imaging guidance of the ablation device to the tumor, thermal treatment, post-treatment care and follow-up.

热消融治疗腹部肿瘤

Percutaneous thermal ablation is an emerging treatment option for many tumors of the abdomen not amenable to conventional treatments. During a thermal ...

科研

医学

Cannulation of the Mouse Submandibular Salivary Gland via the Wharton's Duct

Severe salivary gland hypofunction is frequently found in patients with Sj&ouml;gren's syndrome and those who receiving therapeutic 
irradiation in their head and neck regions for cancer treatment. Both groups of patients experience symptoms such as xerostomia (dry mouth), dysphagia 
(impaired chewing and swallowing), severe dental caries, altered taste, oro-pharyngeal infections (candidiasis), mucositis, pain and discomfort.
One innovative approach of regenerative medicine for the treatment of salivary gland hypo-function is speculated in RS Redman, E Mezey 
et al. 2009: stem cells can be directly deposited by cannulation into the gland as a potent method in reviving the functions of the impaired organ. Presumably, 
the migrated foreign stem cells will differentiate into glandular cells to function as part of the host salivary gland. Also, this cannulation technique is an 
expedient and effective delivery method for clinical gene transfer application.
Here we illustrate the steps involved in performing the cannulation procedure on the mouse submandibular salivary gland via the Wharton's duct 
(Fig 1). C3H mice (Charles River, Montreal, QC, Canada) are used for this experiment, which have been kept under clean conventional conditions at 
the McGill University animal resource center. All experiments have been approved by the University Animal Care Committee and were in accordance with the 
guidelines of the Canadian Council on Animal Care.
For this experiment, a trypan blue solution is infused into the gland through the opening of the Wharton's duct using a 
insulin syringe with a 29-gauge needle encased inside a polyethylene tube. Subsequently, the mouse is dissected to show that the infusions migrated 
into the gland successfully.

A protocol for the cannulation of the mouse submandibular salivary gland via the Wharton's duct is described. For this experiment, the trypan blue solution is used as a dyer to demonstrate how this technique effectively delivers infusions into the targeted gland, and to suggest the reliability of this new approach as a potential clinical drug/cell therapy for the regeneration of salivary glands.

沃顿商学院的导管插管通过小鼠颌下腺唾液腺

Severe salivary gland hypofunction is frequently found in patients with Sj&ouml;gren's syndrome and those who receiving therapeutic 
irradiation in their ...

The Measurement and Treatment of Suppression in Amblyopia

Amblyopia, a developmental disorder of the visual cortex, is one of the leading causes of visual dysfunction in the working age population. Current estimates put the prevalence of amblyopia at approximately 1-3%1-3, the majority of cases being monocular2. Amblyopia is most frequently caused by ocular misalignment (strabismus), blur induced by unequal refractive error (anisometropia), and in some cases by form deprivation.
Although amblyopia is initially caused by abnormal visual input in infancy, once established, the visual deficit often remains when normal visual input has been restored using surgery and/or refractive correction. This is because amblyopia is the result of abnormal visual cortex development rather than a problem with the amblyopic eye itself4,5 . Amblyopia is characterized by both monocular and binocular deficits6,7 which include impaired visual acuity and poor or absent stereopsis respectively. The visual dysfunction in amblyopia is often associated with a strong suppression of the inputs from the amblyopic eye under binocular viewing conditions8. Recent work has indicated that suppression may play a central role in both the monocular and binocular deficits associated with amblyopia9,10 .
Current clinical tests for suppression tend to verify the presence or absence of suppression rather than giving a quantitative measurement of the degree of suppression. Here we describe a technique for measuring amblyopic suppression with a compact, portable device11,12 . The device consists of a laptop computer connected to a pair of virtual reality goggles. The novelty of the technique lies in the way we present visual stimuli to measure suppression. Stimuli are shown to the amblyopic eye at high contrast while the contrast of the stimuli shown to the non-amblyopic eye are varied. Patients perform a simple signal/noise task that allows for a precise measurement of the strength of excitatory binocular interactions. The contrast offset at which neither eye has a performance advantage is a measure of the "balance point" and is a direct measure of suppression. This technique has been validated psychophysically both in control13,14 and patient6,9,11 populations.
In addition to measuring suppression this technique also forms the basis of a novel form of treatment to decrease suppression over time and improve binocular and often monocular function in adult patients with amblyopia12,15,16 . This new treatment approach can be deployed either on the goggle system described above or on a specially modified iPod touch device15.

Amblyopia is a developmental disorder of the visual cortex that is often accompanied by strong suppression of one eye. We present a new technique for measuring and treating interocular suppression in patients with amblyopia that can be deployed using virtual reality goggles or a portable iPod Touch device.

测量和制止在弱视治疗

Amblyopia, a developmental disorder of the visual cortex, is one of the leading causes of visual dysfunction in the working age population. Current ...

The Goeckerman Regimen for the Treatment of Moderate to Severe Psoriasis

Psoriasis is a chronic, immune-mediated inflammatory skin disease affecting approximately 2-3% of the population. The Goeckerman regimen consists of exposure to ultraviolet B (UVB) light and application of crude coal tar (CCT). Goeckerman therapy is extremely effective and relatively safe for the treatment of psoriasis and for improving a patient's quality of life. In the following article, we present our protocol for the Goeckerman therapy that is utilized specifically at the University of California, San Francisco. This protocol details the preparation of supplies, administration of phototherapy and application of topical tar. This protocol also describes how to assess the patient daily, monitor for adverse effects (including pruritus and burning), and adjust the treatment based on the patient's response. Though it is one of the oldest therapies available for psoriasis, there is an absence of any published videos demonstrating the process in detail. The video is beneficial for healthcare providers who want to administer the therapy, for trainees who want to learn more about the process, and for prospective patients who want to undergo treatment for their cutaneous disease.

Psoriasis is a chronic, immune-mediated inflammatory skin disease. The Goeckerman regimen, formulated for the treatment of psoriasis, consists of exposure to ultraviolet B (UVB) light and application of crude coal tar (CCT). The following protocol is for the administration of Goeckerman therapy for the treatment of moderate-to-severe psoriasis.

Goeckerman方案用于治疗中度至重度牛皮癣

Psoriasis is a  chronic, immune-mediated inflammatory skin disease affecting approximately 2-3%  of the population. The Goeckerman regimen consists of ...

Evaluation of a Novel Laser-assisted Coronary Anastomotic Connector - the Trinity Clip - in a Porcine Off-pump Bypass Model

To simplify and facilitate beating heart (i.e., off-pump), minimally invasive coronary artery bypass surgery, a new coronary anastomotic connector, the Trinity Clip, is developed based on the excimer laser-assisted nonocclusive anastomosis technique. The Trinity Clip connector enables simplified, sutureless, and nonocclusive connection of the graft to the coronary artery, and an excimer laser catheter laser-punches the opening of the anastomosis. Consequently, owing to the complete nonocclusive anastomosis construction, coronary conditioning (i.e., occluding or shunting) is not necessary, in contrast to the conventional anastomotic technique, hence simplifying the off-pump bypass procedure. Prior to clinical application in coronary artery bypass grafting, the safety and quality of this novel connector will be evaluated in a long-term experimental porcine off-pump coronary artery bypass (OPCAB) study. In this paper, we describe how to evaluate the coronary anastomosis in the porcine OPCAB model using various techniques to assess its quality. Representative results are summarized and visually demonstrated.

This paper describes a novel nonocclusive coronary anastomotic connector in a porcine off-pump coronary artery bypass (OPCAB) model. This easy-to-use coronary connector has intrinsic potential to facilitate minimally invasive OPCAB surgery.

评价一种新型激光辅助冠状动脉吻合口连接器 - 三位一体夹 - 在猪非体外循环旁路模式

To simplify and facilitate beating heart (i.e., off-pump), minimally invasive coronary artery bypass surgery, a new coronary anastomotic connector, the ...

Network Analysis of Foramen Ovale Electrode Recordings in Drug-resistant Temporal Lobe Epilepsy Patients

Approximately 30% of epilepsy patients are refractory to antiepileptic drugs. In these cases, surgery is the only alternative to eliminate/control seizures. However, a significant minority of patients continues to exhibit post-operative seizures, even in those cases in which the suspected source of seizures has been correctly localized and resected. The protocol presented here combines a clinical procedure routinely employed during the pre-operative evaluation of temporal lobe epilepsy (TLE) patients with a novel technique for network analysis. The method allows for the evaluation of the temporal evolution of mesial network parameters. The bilateral insertion of foramen ovale electrodes (FOE) into the ambient cistern simultaneously records electrocortical activity at several mesial areas in the temporal lobe. Furthermore, network methodology applied to the recorded time series tracks the temporal evolution of the mesial networks both interictally and during the seizures. In this way, the presented protocol offers a unique way to visualize and quantify measures that considers the relationships between several mesial areas instead of a single area.

This protocol describes a procedure to track the evolution of mesial network measures in temporal lobe epilepsy (TLE) patients. It is based on the combination of intracranial recordings with a novel numerical technique for data analysis. Specifically, we present a protocol for network analyses of foramen ovale recordings.

在耐药性颞叶癫痫患者卵圆孔电极记录的网络分析

Approximately 30% of epilepsy patients are refractory to antiepileptic drugs. In these cases, surgery is the only alternative to eliminate/control ...

Nerve-sparing Mid-urethral Obstruction (NeMO) in Female Small Rodents

Partial bladder outlet obstruction (pBOO) has a high prevalence, causes significant patient burden, and immense health care costs. The most common animal model to investigate bladder remodeling in pBOO are female rodents undergoing partial obstruction at the proximal urethra. Variability in the degree of obstruction and animal mortality are major concerns with proximal obstruction. Furthermore, dissecting around the proximal urethra and bladder neck jeopardizes bladder innervation.
We developed a nerve-sparing mid-urethral obstruction (NeMO) model for pBOO avoiding the disadvantages of the traditional model. We approached the urethra just inferior to the pubic symphysis, which obviated the need for laparotomy as well as for dissection in this area; also, the striated urethral sphincter remained untouched. We performed NeMO in female Sprague-Dawley rats (12 obstructions, 6 sham animals) as well as in female C57/bl6 mice (20 obstructions, 18 sham animals). After two weeks, we evaluated bladder function, bladder mass, and body mass.
We had no mortalities among obstructed- or sham-operated female rats; as described for the traditional proximal pBOO-method, we tied the suture around the proximal urethra and a temporarily placed 0.9 mm metal rod. NeMO induced an 85% increase in bladder mass after two weeks, average residual urine volume was 0.4 mL in partially obstructed rats while only 0.03 mL in sham animals. In mice, we tested 3 sizes of cannulas that we placed along the urethra when tying the suture. We found that using a 27-gauge cannula resulted in over 50% animal mortality; placing the 25-gauge cannula did not yield the desired response in increasing bladder mass; utilizing a 26-gauge cannula yielded favorable results with minimal animal mortality (1/8) yet a significant 2-fold increase in bladder mass.

Nerve-sparing Mid-urethral Obstruction NeMO in Female Small Rodents

Traditional modeling of partial bladder outlet obstruction in rodents is fraught with animal mortality. A denervation injury from dissection around the proximal urethra and bladder neck is also of major concern. We developed and evaluated a safe and reliable mid-urethral obstruction model, avoiding the shortcomings of the traditional model.

在女小鼠害保留神经的中期尿道梗阻（NEMO）

Partial bladder outlet obstruction (pBOO) has a high prevalence, causes significant patient burden, and immense health care costs. The most common animal ...

Trans-Tympanic Drug Delivery for the Treatment of Ototoxicity

The systemic administration of protective agents to treat drug-induced ototoxicity is limited by the possibility that these protective agents could interfere with the chemotherapeutic efficacy of the primary drugs. This is especially true for the drug cisplatin, whose anticancer actions are attenuated by antioxidants which provide adequate protection against hearing loss. Other current or potential otoprotective agents could pose a similar problem, if administered systemically. The application of various biologicals or protective agents directly to the cochlea would allow for high levels of these agents locally with limited systemic side effects. In this report, we demonstrate a trans-tympanic method of delivery of various drugs or biological reagents to the cochlea, which should enhance basic science research on the cochlea and provide a simple way of directing the use of otoprotective agents in the clinics. This report details a method of trans-tympanic drug delivery and provides examples of how this technique has been used successfully in experimental animals to treat cisplatin ototoxicity.

We present a technique for localized administration of drugs through the trans-tympanic route into the cochlea. Drug delivery through this route would not interfere with the anti-cancer efficacy of the chemotherapeutic drugs such as cisplatin.

经鼓膜药物治疗耳毒性的临床研究

The systemic administration of protective agents to treat drug-induced ototoxicity is limited by the possibility that these protective agents could ...

Enucleation of the Prostate for the Treatment of Benign Prostatic Hyperplasia Using a 980 nm Diode Laser

In the aging male population, the occurrence of lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH) is a common problem. Here, we introduce a new technique called 980 nm diode laser enucleation (DiLEP) to treat BPH1. Diode lasers can absorb both water and hemoglobin at the same time, so they are good for cutting and hemostasis2. The diode laser was approved by the FDA in 2007, and has been used in the treatment of BPH because of its effective cutting and hemostasis effect3. DiLEP presents several advantages over other techniques, such as TURP, HoLEP, and PVP. During the procedure, we define the boundary of a high-volume prostate and separate it into three lobes with a diode laser by burning two rings and one groove (like a Cupid&#39;s arrow). Compared to other procedures, mDiLEP has fewer intraoperative complications, a shorter learning curve, and achieves more tissue resection.

Here, we present a protocol for modified 980 nm diode laser enucleation to treat large volume benign prostatic hyperplasia.

使用 980 nm 二极管激光进行前列腺摘除术治疗良性前列腺增生

In the aging male population, the occurrence of lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH) is a common problem. ...

Development of a Noninvasive, Laser-Assisted Experimental Model of Corneal Endothelial Cell Loss

Nd:YAG lasers have been used to perform noninvasive intraocular surgery, such as capsulotomy for several decades now. The incisive effect relies on the optical breakdown at the laser focus. Acoustic shock waves and cavitation bubbles are generated, causing tissue rupture. Bubble sizes and pressure amplitudes vary with pulse energy and position of the focal point. In this study, enucleated porcine eyes were positioned in front of a commercially available Nd:YAG laser. Variable pulse energies as well as different positions of the focal spots posterior to the cornea were tested. Resulting lesions were evaluated by two-photon microscopy and histology to determine the best parameters for an exclusive detachment of corneal endothelial cells (CEC) with minimum collateral damage. The advantages of this method are the precise ablation of CEC, reduced collateral damage, and above all, the non-contact treatment.

Here, we present a protocol to detach corneal endothelial cells (CEC) from Descemet&#8217;s membrane (DM) using a neodymium:YAG (Nd:YAG) laser as an ex vivo disease model for bullous keratopathy (BK).

角膜内皮细胞损失非侵入性激光辅助实验模型的发展

Nd:YAG lasers have been used to perform noninvasive intraocular surgery, such as capsulotomy for several decades now. The incisive effect relies on the ...